Healthcare Provider Details

I. General information

NPI: 1639141898
Provider Name (Legal Business Name): CARA R LACEY-MOREY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA RENEE MOREY SLP

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NE SCOTT AVE
GRESHAM OR
97030-6147
US

IV. Provider business mailing address

550 NE SCOTT AVE
GRESHAM OR
97030-6147
US

V. Phone/Fax

Practice location:
  • Phone: 503-512-0825
  • Fax:
Mailing address:
  • Phone: 503-512-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12108
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20932
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2436
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP7921
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: